A Cause of Bilateral Chylothorax: A Case of Mesothelioma without Pleural Involvement during Initial Diagnosis

Chylothorax is characterized by fluid accumulation in the pleural cavity containing chylomicrons due to disruption of lymphatic drainage in the thoracic ductus and development of chylothorax. A 60-year-old male patient presented to our clinic with shortness of breath and displayed bilateral pleural effusion and diffuse mediastinal lymph nodes in his computed chest tomography images. There were no thickening and nodular formation on the pleural surfaces. PET-CT showed no pathological FDG uptake. Thoracentesis showed a chylous effusion. Drainage reduced during monitoring could not be stopped; therefore, surgical intervention was considered. The patient underwent right thoracotomy. There were no pathological findings in the parietal and visceral pleura during the surgery. Initially lymphoma was considered. Perioperative samples were collected from the mediastinal lymph node. The pathology analysis reported metastasis of malignant mesothelioma. Evaluation of a repeated chest computed tomography showed nodular formations on the pleural surfaces. Mediastinal lymph nodes compressed the ductus thoracicus, resulting with chylothorax. The present case, with malignant mesothelioma, bilateral chylothorax, and mediastinal lymph node without any pleural involvement during initial diagnosis, is rare and will hence contribute to the literature.

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From Raw Pixels to Recurrence Image for Deep Learning of Benign and Malignant Mediastinal Lymph Nodes on Computed Tomography

10.36227/techrxiv.13246337 ◽

2020 ◽

Author(s):

Tuan Pham

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Deep Learning ◽

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Survival Rates ◽

Primary Lung Cancer ◽

Lymph Node Status ◽

Mediastinal Lymph Nodes

<div>Lung cancer causes the most cancer deaths worldwide and has one of the lowest five-year survival rates of all cancer types. It is reported that more than half of patients with lung cancer die within one year of being diagnosed. Because mediastinal lymph node status is the most important factor for the treatment and prognosis of lung cancer, the aim of this study is to improve the predictive value in assessing the computed tomography (CT) of mediastinal lymph-node malignancy in patients with primary lung cancer. This paper introduces a new method for creating pseudo-labeled images of CT regions of mediastinal lymph nodes by using the concept of recurrence analysis in nonlinear dynamics for the transfer learning. Pseudo-labeled images of original CT images are used as input into deep-learning models. Three popular pretrained convolutional neural networks (AlexNet, SqueezeNet, and DenseNet-201) were used for the implementation of the proposed concept for the classification of benign and malignant mediastinal lymph nodes using a public CT database. In comparison with the use of the original CT data, the results show the high performance of the transformed images for the task of classification. The proposed method has the potential for differentiating benign from malignant mediastinal lymph nodes on CT, and may provide a new way for studying lung cancer using radiology imaging. </div><div><br></div>

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Problem of a Mediastinal Lymph Node Dissection for the Left Lung Cancer-Significance of the Bilateral Mediastinal Lymph Node Dissection Considering the Last Mediastinal Lymph Nodes-.

Haigan ◽

10.2482/haigan.43.121 ◽

2003 ◽

Vol 43 (2) ◽

pp. 121-124

Author(s):

Makoto Yano ◽

Nobuo Ogawa ◽

Naoki Ishiwa ◽

Hideyuki Ito ◽

Hideto Okuwaki ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Mediastinal Lymph Node ◽

Left Lung ◽

Mediastinal Lymph Node Dissection ◽

Mediastinal Lymph Nodes ◽

Node Dissection

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01289-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectives Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Endoscopic ultrasound in the diagnosis of mediastinal diseases

Open Medicine ◽

10.1515/med-2015-0095 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Zhiguo Wang ◽

Chunmeng Jiang

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Endoscopic Ultrasound ◽

Mediastinal Lymph Node ◽

Lymph Node Status ◽

Mediastinal Lymph Nodes ◽

Mediastinal Diseases ◽

Mediastinal Lymphoma ◽

Tissue Acquisition

AbstractEUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends.

10.21203/rs.3.rs-46826/v2 ◽

2020 ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectivesEvidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients.MethodsThis retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models.Results152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time.ConclusionsDiffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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Recursive Partitioning Analysis of Mediastinal N2 Lymph Node Involvement with Selected Biological Markers in Operable Non-small Cell Lung Cancer: A Correlative Study

Biomarker Insights ◽

10.1177/117727190700200004 ◽

2007 ◽

Vol 2 ◽

pp. 117727190700200

Author(s):

H Bozcuk ◽

A Gumus ◽

G Ozbilim ◽

A Sarper ◽

I Kucukosmanoglu ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Recursive Partitioning ◽

Lymph Node Involvement ◽

Mediastinal Lymph Nodes ◽

Group Affiliation ◽

Small Cell Lung ◽

Mediastinal Lymph Node Involvement ◽

Node Involvement

Background Expressions of various biomarkers in non-small cell lung cancer (NSCLC) have been linked with the prognosis and involvement of mediastinal lymph nodes. Methods In this study, we utilized recursive partitioning analysis (RPA) by using P53, c-erb-B2, and P-glycoprotein (PGP) expressions evaluated by immunohistochemistry to estimate retrospectively the likelihood of the occult N2 mediastinal lymph node involvement in patients with operable NSCLC. Results In univariate tests, immunohistochemical staining of the primary tumor for these 3 markers in 61 patients undergoing surgery revealed no direct relationship with the N2 involvement. However, RPA demonstrated in patients aged <75 and with ≥4 mediastinal lymph nodes removed that, high PGP expression frequency (≥20%) predicted an increased likelihood of the N2 involvement (46.7%, R2 = 0.25). Univariate nominal logistic regression analysis revealed that RPA group affiliation, and the number of mediastinal lymph nodes resected (logarithmic transformation) were associated with the metastasis to N2 lymph nodes (χ2 = 17.59, p = 0.0005, and χ2 = 2.40, p = 0.0654, respectively). Multivariate analysis confirmed that only RPA group affiliation predicted the N2 involvement (χ2 = 14.63, p = 0.0022). Conclusion This study shows for the first time that PGP expression of the primary tumor may help to predict the occult N2 mediastinal lymph node involvement in NSCLC. Thus, further research is required to understand whether PGP expression may aid in the decision process for preoperative mediastinoscopy.

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PS01.108: SPONTANEOUS ESOPHAGOCUTANEOUS FISTULA IN KIKUCHI DISEASE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.108 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 80-80

Author(s):

Kelvin Voon ◽

Mustafa Mohammed Taher ◽

Reynu Rajan ◽

Nik Ritza Kosai

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Fistula Tract ◽

Mediastinal Lymphadenopathy ◽

Esophageal Fistula ◽

Mediastinal Lymph Nodes ◽

Transhiatal Approach ◽

Laparoscopic Excision ◽

Paraspinal Abscess

Abstract Background Kikuchi disease is a rare, self-limiting condition that is characterized by histiocytic necrotizing lymphadenitis with unknown pathogenesis. Common presentation is cervical lymphadenopathy and fever in a previously well young female. Mediastinal lymph node involvement is uncommon. Methods We report a case of spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymphadenopathy in a patient with Kikuchi disease. Results A 38-year-old lady presented with fever and right back pain of two weeks duration. She had background history of Kikuchi disease which was diagnosed 1 year ago. Examination revealed multiple enlarged left cervical lymph nodes and right back tenderness. CT scan showed an esophagocutaneous fistula with right paraspinal abscess and multiple enlarged cervical and mediastinal lymph nodes. OGDS revealed a 5mm fistula opening at right posterior wall of distal esophageal, 3cm proximal to esophagogastric junction. Rest of esophagus and stomach were normal. Tuberculosis and SLE workup were negative. Cervical lymph node biopsy was consistent with Kikuchi disease. She was treated as spontaneous esophagocutaneous fistula secondary to necrotizing mediastinal lymph node with underlying Kikuchi disease. Percutaneous drainage of paraspinal abscess was done and antibiotics were commenced. Laparoscopic feeding jejunostomy was done for feeding. Esophageal stenting and endoscopic clipping of fistula were attempted but the fistula tract persisted. She then underwent laparoscopic excision of esophageal fistula tract (LEEFT). Intraoperative findings were dense inflamed paraesophageal tissue with thickened fistula tract at right posterolateral wall of distal esophagus with multiple enlarged mediastinal lymph nodes. Fistula tract and the lymph nodes were excised via laparoscopic transhiatal approach. She had an uneventful recovery and was discharged on post-operative day 7. Conclusion Spontaneous esophageal fistula is rare and necrotizing mediastinal lymphadenopathy needs to be considered. Laparoscopic excision of esophageal fistula tract (LEEFT) is a novel transhiatal approach and it is feasible in distally located fistula. Disclosure All authors have declared no conflicts of interest.

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Reactive Mediastinal Lympadenopathy in Bronchiectasis Assessed by CT

Acta Radiologica ◽

10.1177/028418519303400513 ◽

1993 ◽

Vol 34 (5) ◽

pp. 489-491 ◽

Cited By ~ 5

Author(s):

R. D. Thomas ◽

R. M. Blaquiere

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Maximum Size ◽

Mediastinal Lymphadenopathy ◽

Mediastinal Lymph Nodes ◽

Disease States ◽

Size Number ◽

Lymph Node Enlargement ◽

Specific Finding

Mediastinal lymphadenopathy is commonly detected on CT. It is a non-specific finding, but because of its significance in the treatment in lung carcinoma it is important to know with which other disease states it is associated. We present a series of 42 patients in whom CT of the chest was used to confirm a clinical diagnosis of bronchiectasis. The size, number and distribution of mediastinal lymph nodes is documented. Lymph nodes were visible in 81% of patients. Nodes larger than 10 mm, the recognised maximum size for normal nodes in the U. K., were detected in 29%. In the absence of other recognised causes of lymphadenopathy in these patients, these findings confirm “reactive” mediastinal lymph node enlargement in bronchiectasis.

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Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

10.21203/rs.3.rs-46826/v1 ◽

2020 ◽

Author(s):

Giacomo Sgalla ◽

Anna Rita Larici ◽

Nicoletta Golfi ◽

Mariarosaria Calvello ◽

Alessandra Farchione ◽

...

Keyword(s):

Lymph Node ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lymph Nodes ◽

Ct Scan ◽

Disease Progression ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Nodes ◽

Lymph Node Enlargement

Abstract Background and objectives: Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods: This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results: 152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions: Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

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From Raw Pixels to Recurrence Image for Deep Learning of Benign and Malignant Mediastinal Lymph Nodes on Computed Tomography

10.36227/techrxiv.13246337.v1 ◽

2020 ◽

Author(s):

Tuan Pham

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Deep Learning ◽

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Survival Rates ◽

Primary Lung Cancer ◽

Lymph Node Status ◽

Mediastinal Lymph Nodes

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